Service Guidelines: III-C1 Congregate Meals 1

SERVICE GUIDELINES TITLE III-C1 Congregate Meals /

Nutrition Services Incentive Program (NSIP) December 2015 DEFINITION CONGREGATE MEALS (CM): Provision of nutritious meals to eligible persons in a congregate setting. SERVICES THAT MAY BE FUNDED Eligible services include the preparation and serving of meals, outreach to potential participants and nutrition education in a pleasant home-like setting. ELIGIBILITY Individuals, aged 60 or older, and the spouses of those individuals, regardless of age, if the eligible spouse is or has been an active participant in the program. Eligible spouses include individuals of the same sex, who are legally married within in any jurisdiction; regardless of whether the individuals are a permanent resident of a jurisdiction, state, or territory that does not recognize same sex marriage. The intention is to include all legal marriages, regardless of the individual’s current residence. Disabled individuals [as defined in Older Americans Act of 1965, as Amended, (OAA) Section 102(8)(9)] who have not attained 60 years of age but who reside in housing facilities occupied primarily by the elderly at which congregate nutrition services are provided. Individuals with disabilities who reside at home with and accompany individuals, aged 60 or older. Individuals with disabilities who are children by marriage, of legally married same sex spouses; who reside at home with individuals aged 60 or older.

Service Guidelines: III-C1 Congregate Meals 2 UNIT OF SERVICE Each meal provided to an eligible person constitutes one unit of service. SERVICE REQUIREMENTS

Approval of Congregate Sites AgeSmart shall approve or disapprove operation of Congregate Sites proposed in the grant application and possible extension(s). A priority of AgeSmart is to assure that Congregate Sites are located within areas that have large concentrations of persons 60+ and of persons with greatest economic and social needs.

Site Attendance

All Congregate Sites must have reasonable market penetration of persons 60+ for the region served. Grantees are required to serve at least twenty-five (25) meals to older adults daily at each site.

Exceptions and Waivers to Attendance Standards

Nutrition Service Grantees may request a waiver of site attendance requirements in conjunction with submission of their grant application or extension(s). Waivers may also be requested in writing during the fiscal year. The Waiver requests should detail how the site will meet the congregate standards, either for attendance minimums or market penetration, or be supported with outside resources. A public hearing will be held in the proposed location to obtain public input on the proposed waiver or potential site closure. New Congregate Sites will be waived attendance standards for six months to allow for marketing efforts to take effect.

Site Closing and/or Relocations

All Congregate Site closings or relocations require prior approval from AgeSmart. (Agency Policies 04.205) AgeSmart may initiate Congregate Site closings and/or relocations by notifying the Nutrition Service Grantee in writing. Further discussions will be held in person or via telephone. Requests initiated by Nutrition Service Grantees must be made in writing with justification given. Upon review by AgeSmart Program and Fiscal staff, the request will be discussed in person or via telephone with the Nutrition Service Grantee.

A Congregate Site or congregate program may also be placed on probationary status because of poor food quality, inadequate facilities, failure to meet health department standards, or for any other stated reason at the sole discretion of AgeSmart.

Nutrition Service Grantees with probationary Congregate Sites, shall submit plans to meet AgeSmart standards. These plans shall be no more than 6 months in duration. Probationary Congregate Sites are expected to meet AgeSmart’s standards within 6 months. Failure to meet AgeSmart’s performance standards

Service Guidelines: III-C1 Congregate Meals 3

may result in the closure of the Congregate Site, site relocation, and/or a 6-month extension and new plan, or grant termination. Severe, chronic problems on many Congregate Sites may result in closure of a Nutrition Service Grantee’s entire CM program.

Information and Assistance

Congregate Meal Grantees that do not have Information & Assistance (I&A) grant shall collaborate with I&A Grantees. A Memorandum of Understanding must be signed between both parties to ensure services. Regular presence of the I & A grantee will ensure consistency of services provided to beneficiaries in the seven county service area.

DATA COLLECTION All participants will be entered into NAPIS. The Congregate Site must keep detailed, legible and accurate daily logs of all attendees.

NAPIS reporting:

• All participants will be entered into NAPIS. • Grantees must keep detailed, legible and accurate daily logs of the

service. • Daily logs should contain signatures of participants receiving services. • Grantees must complete client demographics information in Client

Registration that is required by the State. • Age, Gender, Ethnicity, Race, Number in Household, and Low Income

data must be completed. Grantees may use their best professional judgment and enter the best possible data.

• Number in Household (Living Alone Status): • Enter the number of person(s) in household. Living Alone status is a one

person household where the householder lives by himself/herself in an owned or rented place of residence in a non-institutional setting including assisted living units and group homes.

• Poverty (Low Income): • A person whose income is at or below the federal poverty guidelines is

considered to be in poverty or low income. • The grantees will complete monthly data audit to ensure that client

demographic information is accurate and complete

Reporting Temporary Home Delivered Meals (Sniffle Meals):

When a Nutrition Service Grantee delivers a meal to a regular Congregate Meals participant who is unable to attend the site due to short-term medical condition, the meal is counted as a Congregate Meal NOT a Home Delivered Meal. The Nutrition Service Grantee is expected to keep appropriate records of these meals. (NOTE: Persons who have not participated previously in congregate meals are not eligible for temporary meals).

Service Guidelines: III-C1 Congregate Meals 4 MONITORING Nutrition Service Grantees will be monitored by AgeSmart for compliance in record keeping, food handling, service delivery, donation collection and other necessary areas. Announced and unannounced site visits will be conducted. OTHER REQUIREMENTS The Congregate Site is subject to all applicable AgeSmart, local, state, IDOA and AOA regulations concerning the operation of a CM program, including all applicable state and local health and safety standards, and dietary requirements. Copies of inspection reports and relevant correspondence from other regulatory agencies must be submitted to AgeSmart. Nutrition Service Grantees shall practice full disclosure about its operations and inform AgeSmart of any and all concerns. Grantees will use the AgeSmart logo on facilities, webpages, newsletters and brochures. Brands and logos are available for specific funded services and include ComeIn! To Good Food and Good Company for all Congregate Grantees. Along with branding, the following statement must be used by Grantees:

Funding for Grantee is received from the United States Administration for Community Living, the Illinois Department on Aging and AgeSmart Community Resources. Grantee does not discriminate in admission to programs or activities or treatment of employment in programs or activities in compliance with appropriate State and Federal Statutes. If you feel you have been discriminated against, you have the right to file a complaint with AgeSmart Community Resources by calling 618-222-2561. The Grantee shall conduct pre-employment criminal background checks for all employees of AgeSmart funded programs. The Grantee shall also conduct criminal background checks on volunteers participating in AgeSmart funded programs with access to confidential client information including, but not limited to addresses, social security numbers, financial info, etc. OTHER ELIGIBILITY REQUIREMENTS Nutrition Service Grantees may provide delivered congregate meals during short term closures of a congregate meal site that would prohibit a regular participant of that congregate meal site from receiving a congregate meal. This type of meal delivery must include all regular participants of that congregate meal site who desire that meal and the decision to provide these meals is at the sole discretion of the Nutrition Service Grantee. Recipients of these meals must have previously participated in congregate meals and the meal is counted in NAPIS as a congregate meal, not a home delivered meal, Transportation costs for the delivery of these meals is the responsibility of the Nutrition Service Grantee.

Service Guidelines: III-C1 Congregate Meals 5 Congregate Site Administrators may offer a meal, on the same basis as meals are provided to elderly participants, to individuals providing volunteer services during the meal hours, to staff and/or to guests, if doing so will not deprive an older person of a meal. Staff or guests shall pay for the full cost of the meal. Full cost of the meal includes raw food, labor (personnel), equipment, supplies, utilities/rent, and other. The full cost of the meal is the cash cost and may include in-kind. The Congregate Site Administrator may offer a meal to staff as a fringe benefit. These meals should be included as employee fringe benefit cost in the budget. Employees are responsible for any tax liability on the value of the fringe benefit. IDOA Requirements Service Activities Which May Be Funded Include:

1. Preparation of Meals; 2. Service of Meals; 3. Transport of Meals; 4. Nutrition Education; and 5. Outreach.

Each Congregate Meals provider must:

Provide hot or other appropriate meals (e.g., cold) in a congregate setting at least once a day, five or more days a week (except in a rural area where such frequency is not feasible, and a lesser frequency is approved by IDOA via AgeSmart). AgeSmart may grant an exception(s) when the Nutrition Service Grantee:

• Submits documentation of need for the exception(s); and • Serves meals at least 5 days per week throughout the service area, but

not necessarily 5 days per week at each site; or serves a low-income minority target population.

Locate congregate nutrition services in a site in as close proximity to the majority

of eligible individual’s residences as feasible, with particular attention upon a multipurpose senior center, a school, a church, or other appropriate community facility, preferably within walking distance where possible, and where appropriate, transportation to such site is available; provisions must be made for parking, convenience, and transportation to such site is available. Since multipurpose senior centers offer other services (e.g., information and assistance, transportation, recreation, education, health promotion, etc.) to older adults, whenever feasible, congregate meal sites should be located in such facilities. Facilities should be barrier free and adapted to the needs of the frail elderly.

Service Guidelines: III-C1 Congregate Meals 6

Establish outreach activities, which assure that the maximum number of eligible individuals may have an opportunity to participate.

Coordinate with other appropriate services in the community. Signed

Memorandum of Understanding between the grantee and other community services must be submitted to AgeSmart.

If operated by special interest groups, such as churches, social organizations,

homes for the elderly, senior housing developments, etc., shall not limit participation to their own membership or otherwise show preferential treatment for such membership.

Have procedures for obtaining the views of participants about the services they

receive and involve participants in the planning and operation of nutrition services and other programs provided for their benefit as outlined in Objective 10 of the Older Americans Act;

Solicit the expertise of an Illinois Licensed Dietitian Nutritionist (or Illinois licensed

Health care practitioner whose license includes nutrition services) based on the requirements of the state Dietetic and Nutrition Services Practice Act, Section 15. An individual licensed to practice dietetic or nutrition services in another state that has licensure requirements considered by the Illinois Department of Financial and Professional Regulation to be at least as stringent as the requirements for licensure under the Illinois Act, may review and approve menus. Although nutrition service providers do not have to include licensed dietitians on staff, state rules do require that licensed dietitians are involved in the review and approval of menus. Menu planning and review can be arranged through subcontracts or volunteer agreements.

Follow appropriate procedures to preserve nutritional value and food safety in purchasing and storing food, and preparing, serving and delivering meals.

Provide special menus, where feasible and appropriate, to meet the particular

dietary needs arising from the health requirements, religious requirements, ethnic or cultural backgrounds of eligible individuals.

Have available for use upon request appropriate food containers and utensils for

persons with disabilities.

Procure, maintain, and furnish AgeSmart with documentation of (on request) the following:

• Comprehensive bodily injury and property damage liability

(liability amounts $300,000/$100,000 each occurrence) and

• Product liability (amount to be determined by Grantee to meet needs).

Procedures for weather-related and other emergencies that may prevent

Service Guidelines: III-C1 Congregate Meals 7 the delivery of service must be provided to AgeSmart within 90 days of grant award notification or no later than December of the fiscal year in which the grant was awarded. NUTRITION EDUCATION SERVICES/WELLNESS PROGRAMS

Each Congregate Site shall provide nutrition education on at least a semiannual basis to the participants. It is strongly recommended that nutrition education be provided quarterly to congregate participants and more frequently if possible. The purpose of nutrition education is to inform individuals about available facts and information that will promote improved food selection, eating habits, nutrition and health-related practices. These activities are designed to:

• Assist older persons in obtaining the best nutritional services available

within their resources; • Aid older persons in making sound food choices consistent with the

Dietary Guidelines for Americans, and in obtaining the best food to meet nutritional needs;

• Increase awareness of community-sponsored health programs that encourage and promote sound nutritional habits and good health; and

• Assist older persons, where feasible, in the area of therapeutic diets as required by health or social condition.

• Coordinate with community resources is encouraged in the provision of nutrition education services.

The Congregate grantee shall provide or host at least one evidence-based

wellness program per year. To complete this requirement, coordination with AgeSmart’s evidence-based wellness programs is highly encouraged.

MEAL REQUIREMENTS Meals provided through the CM program must comply with the Dietary Guidelines for Americans, published by the Secretary of Health and Human Services and the Secretary of Agriculture; and provide each participant: Service providers who choose not to complete a nutritional analysis of their menus will follow the meal pattern described in this section.

Requirements for One or Two Meal(s) Daily Each meal must provide*: (1) Serving lean meat or meat alternate: 3 ounces of edible cooked meat, fish, fowl, eggs or meat alternate (2) Serving(s) vegetables: ½ cup equivalent – may serve an additional vegetable instead of a fruit

Service Guidelines: III-C1 Congregate Meals 8 (1) Serving fruit: ½ cup equivalent – may serve an additional fruit instead of a vegetable (2) Servings grain, bread or bread alternate, preferably whole grain: for example, 2 slices of whole grain or enriched bread 1 ounce each or 1 cup cooked pasta or rice (1) Serving fat free or low fat milk or milk alternate: 1 cup equivalent *Margarine and dessert are optional and must be counted in the calories, fat and sodium totals, if served in addition to above components.

Requirements for Three Meals Daily The three meals combined must provide: (2) Servings lean meat or meat alternate: 6 ounces of edible cooked meat, fish, fowl, eggs or meat alternate (3-4) Servings vegetables (2-3) Servings fruit (6-9) Servings whole grain/enriched grain, bread or bread alternate (3) Servings fat free or low fat milk or milk alternate ILLINOIS LINK The Nutrition Service Grantee must assist participants in taking advantage of benefits available to them under the Illinois LINK program. The Nutrition Service Grantee may coordinate its activities with the local Illinois Department of Human Services office administering the LINK program to facilitate participation of eligible persons in the program. NUTRITION STANDARDS

In purchasing food, and preparing and delivering meals, the Nutrition Service Grantees must follow appropriate procedures to preserve nutritional value and food safety.

The Nutrition Service Grantee must comply with all State and local health laws and ordinances concerning preparation, handling and serving food.

MEAL PLANNING Menus must be:

Service Guidelines: III-C1 Congregate Meals 9

Planned in advance for a minimum of one month with repetition of entrees and other menu items kept at a minimum. If a cycle menu is utilized, there shall be at least three cycles per year. If the cycle is at least 6 weeks or greater in length, there shall be at least 2 cycles per year;

Approved by the provider’s licensed dietitian nutritionist as defined in the IDOA

service guidelines listed previously.

Posted with serving dates indicated in a location conspicuous to participants at each congregate meal site as well as in each preparation area;

Legible and easy to read (It is recommended that menus be printed in the

language(s) of the participant group.);

Adhered to, subject to seasonal availability of food items; and

Kept on file with the signed menu approval sheet, with any changes noted in writing, for at least three years.

MENU PATTERN Grantees shall use the menu pattern for each meal that follows:

Meat or Meat Alternate • Three ounces (providing at least 19 g protein) of lean meat, poultry, fish or meat alternate should generally be provided for the lunch or supper meal. Meat serving weight is the edible portion, not including skin, bone, or coating. • Meat (1 ounce) alternates include: 1 medium egg 1-ounce cheese (nutritionally equivalent measure of pasteurized process cheese, cheese food, cheese spread, or other cheese product) ½ cup cooked dried beans, peas or lentils 2 tablespoons peanut butter or 1/3 cup nuts ¼ cup cottage cheese ½ cup tofu 1 ounce of soy type burger

Service Guidelines: III-C1 Congregate Meals 10 • A one ounce serving or equivalent portion of meat, poultry, fish, may be served in combination with other high protein foods. • Protein/lean meat /meat alternate items containing textured vegetable protein and providing at least 19 g protein in a (3 oz) serving may be served. • Except to meet cultural and religious preferences and for emergency meals, serving dried beans, peas or lentils, peanut butter or peanuts, and tofu for consecutive meals or on consecutive days should be avoided. • Imitation cheese (which the Food and Drug Administration defines as one not meeting nutritional equivalency requirements for the natural, non-imitation product) cannot be served as meat alternates. • To limit the sodium content of the meals, serve no more than once a week cured and processed meats (e.g., ham, smoked or Polish sausage, corned beef, wieners, luncheon meats, dried beef). • To limit the amount of fat, especially saturated fat, and cholesterol in meals, regular ground meat should be served no more than twice weekly when one meal is provided, four times weekly if two meals are provided, and no more than 6 times a week if three meals are provided.

Vegetables • A serving of vegetable (including cooked dried beans, peas and lentils) is generally ½ cup cooked or raw vegetable; or ¾ cup 100% vegetable juice, or 1-cup raw leafy vegetable. For pre-packed 100% vegetable juices, a ½ cup juice pack may be counted as a serving if a ¾ cup pre-packed serving is not available. • Fresh, frozen or unsalted canned vegetables are preferred instead of canned vegetables containing salt. • Vegetables as a primary ingredient in soups, stews, casseroles or other combination dishes should total ½ cup per serving. • At least one serving from each of the five vegetable subgroups must be included in a weekly menu. The five vegetable subgroups include dark green vegetables, orange vegetables, cooked dry beans and peas, starchy vegetables, and “other” vegetables.

Service Guidelines: III-C1 Congregate Meals 11 • A serving of cooked legumes (dried beans, peas and lentils) must be included twice each week, if one meal is provided; 4 servings per week must be included, if two or three meals are provided.

Fruits • A serving of a fruit is generally a medium apple, banana, orange, or pear; ½ cup chopped, cooked, or canned fruit; or ¾ cup 100% fruit juice. For pre-packed 100% fruit juices, a ½ cup juice pack may be counted as a serving if a ¾ cup pre-packed serving is not available. • Fresh, frozen, or canned fruit will preferably be packed in juice, without sugar or light syrup

Grain, Bread or Bread Alternate • A serving of grain or bread is generally 1 slice (1 ounce), whole grain or enriched; ½ cup cooked whole grain or enriched pasta or grain product; or 1 ounce of ready-to-eat cereal. Priority should be given to serving whole grains. Grain, bread and bread alternates include: 1 small 2-ounce muffin, 2” diameter 2 mini muffins 2” cube cornbread 1 biscuit, 2” diameter 1 waffle, 4” diameter 1 slice French toast ½ slice French toast from “Texas toast” ½ English muffin 1 tortilla, 4-6” diameter 1 pancake, 4” diameter ½ bagel 1 small sandwich bun (<3” diameter)

Service Guidelines: III-C1 Congregate Meals 12 ½ cup cooked cereal 4-6 crackers (soda cracker size) ½ large sandwich bun ¾ cup ready to eat cereal 2 graham cracker squares ½ cup bread dressing/stuffing ½ cup cooked pasta, noodles or rice prepared pie crust, 1/8 of a 8” or 9” two-crust pie ½ cup cooked grain product in serving of fruit “crisp” or cobbler A variety of enriched and /or whole grain products, particularly those high in fiber, are recommended. Two servings whole grain products must be served at least twice a week when one meal is provided; 4 servings whole grain products must be served per week when 2 meals are provided; 6 whole grain products must be served per week when 3 meals are provided. Grain/bread alternates do not include starchy vegetables such as potatoes, sweet potatoes, corn, yams, or plantains. These foods are included in the vegetable food group.

Milk or Milk Alternates One cup skim, low fat, whole, buttermilk, low-fat chocolate milk, or lactose-free milk fortified with Vitamins A and D should be used. Low fat or skim milk is recommended for the general population. Powdered dry milk (1/3 cup) or evaporated milk (½ cup) may be served as part of a home-delivered meal. • Milk alternates for the equivalent of one cup of milk include: 1 cup fat free or low fat milk 1 cup yogurt, fat free or low fat 1 cup fortified soymilk 1 ½ cups cottage cheese, low fat 8 ounces tofu (processed with calcium salt)

Service Guidelines: III-C1 Congregate Meals 13 1½ ounces natural or 2 ounces processed cheese NUTRIENT VALUES FOR MEAL PLANNING AND EVALUATION The table below presents the most current DRIs and other nutrient values to use when planning and evaluating meals. Values are provided for serving 1, or a combination of 2 or 3 meals for 1-day consumption for the average older adult population served by nutrition programs. Menus that are documented** as meeting the nutritional requirements through menu analysis must have written documentation, which supports the following nutrients, are provided:

Nutrient Amount Required Notes Calories (cal) 685 calories per meal

averaged over one week No one meal may be less than 600 calories

Protein (gm)

19

Carbohydrate (gm) 43 Fat (gm) 15-23

≤ 30% calories averaged over one week

No one meal may be more than 35% fat

Fiber (gm) 10 Vitamin A (ug) 300 Vitamin C (mg) 30 Vitamin E (ug) 5 Vitamin B6 (mg) .6 Folate (ug) 133 Vitamin B12 (ug) .8 Calcium (mg) 400 Magnesium (mg) 140 Zinc (mg) 3.7 Potassium (mg) 1567 Sodium (mg) <800, averaged over one

week No one meal more than 1000 mg

**A Menu Approval Sheet is provided to Nutrition Services providers for the licensed dietitian nutritionist to use in documenting that nutritional requirements are met by the menu through meeting the meal pattern requirements or through carrying out a nutritional analysis of menus. Specific Nutrient Sources

Vitamin A

Service Guidelines: III-C1 Congregate Meals 14 Each day each meal must provide at least 300 mg vitamin A through foods served. • To ensure this amount of vitamin A is provided when the meal pattern is followed, vitamin A rich foods must be served 2 to 3 times per week for one meal per day. • When serving 2 meals per day, vitamin A rich foods must be served 4 to 6 times per week. • One rich source or two fair source servings may be used to meet the requirements. • Some examples of rich sources of vitamin A include: Apricots, Cantaloupe, Collard greens, Kale, Mango, Spinach Turnip greens & other dark greens, Winter squash (Hubbard, Acorn, Butternut), Carrots and sweet potatoes • Some examples of fair sources of vitamin A include: Apricot Nectar, Broccoli, Tomato Sauce, Pumpkin, Vegetable Juice

Vitamin C Each day each meal must provide at least 30 mg vitamin C through foods served. • To ensure this amount of vitamin C is provided when the meal pattern is followed, vitamin C may be provided as one serving of a rich source, 2 half servings of rich sources or 2 servings of fair sources. • When serving one meal per day, 1 rich or 2 fair sources must be served. • When serving 2 meals per day, 2 rich or 4 fair sources must be served. • When serving 3 meals per day, 3 rich or 6 fair sources must be served. • Fortified, full-strength juices, defined as fruit juices that are 100% natural juice with vitamin C added, are vitamin C-rich foods. • Partial-strength or simulated fruit juices or drinks, even when fortified, may not count as fulfilling this requirement, except cranberry juice.

Service Guidelines: III-C1 Congregate Meals 15

• Some examples of rich sources of vitamin C include: Broccoli, Brussels sprouts, Cantaloupe, Cauliflower, Fruit juices, fortified Grapefruit, Grapefruit juice, Green pepper, Honeydew, Kale, Kiwi, Mango, Mandarin oranges, Oranges/orange juice, Strawberries, Sweet potatoes, Yams, Sweet red pepper, Tangerines

• Some examples of fair sources of vitamin C include: Asparagus, Cabbage, Collard greens, Mustard greens, Pineapple, Potatoes, Spinach, Tomato/tomato juice/sauce, Turnip greens, Watermelon FOOD PREPERATION RECOMMENDATIONS

When cooking, use salt sparingly or eliminate entirely by using spices, herbs or other seasoning. To flavor foods, use salt-free seasoning, lemon juice, lime juice or vinegar.

Minimize the use of fat in food preparation. Fats should be primarily vegetable

sources and in a liquid or soft (spreadable) form that is low in hydrogenated fat, saturated fat, and cholesterol. Limit fat to no more than 20-35 percent of the calories average for the week.

Each meal should contain at least 10 grams of dietary fiber. Use whole grains,

meat alternatives, and fruits and vegetables to increase the fiber content of the menus. A listing of fiber content of grains, vegetables and fruits is available to service providers. By consulting this listing and ensuring that a minimum of 10 g fiber is included through foods served on a daily basis, providers will meet the fiber requirements.

Reflect seasonal availability of food;

Plan so that food items within the meat and meat alternatives, vegetable, fruit

and grain/bread groups are varied within the week and menu cycle;

Include a variety of foods and preparation methods with consideration for color, combinations, texture, size, shape, taste and appearance;

Do not provide vitamin and/or mineral supplements, except as specified in

Nutrition Supplements below;

Use low-sodium meats, flavorings, and seasonings;

Use low-fat salad dressing, spreads, cheese and gravies (made without drippings and fats);

Bake, broil, steam or stew foods in place of frying food in fat;

Service Guidelines: III-C1 Congregate Meals 16

Provide drinking water to encourage fluid intake. Dehydration is a common problem in older adults. Other beverages such as soft drinks, flavored (preferably sugar-free) drinks, coffee, tea and decaffeinated beverages may be used, but cannot be counted as fulfilling any part of the meal requirements. Nonnutritive beverages do not help meet nutrition requirements but can help with hydration.

Desserts may be provided as an option to satisfy the caloric requirements or for

additional nutrients. Desserts such as fruit, whole grains, low fat or low sugar products are encouraged. Fresh, frozen, or canned fruits packed in their own juice are encouraged often as a dessert item, in addition to the serving of fruit provided as part of the meal. However, if a dessert contains as least ½ cup of fruit it may be counted as a serving of fruit. A dessert containing at least ½ cup enriched/whole grain product may be counted as a serving of grain. For example, a serving of two-crust (approx. 1/8 of 8” or 9” pie) fruit pie that contains at least ½ cup fruit is counted as one serving fruit and one serving grain.

Ethnic or religious menus must approximate as closely as possible (given

religious requirements or ethnic background) the regular meal pattern and nutrient content of meals as previously stated.

Meals served in accordance with the meal standards are appropriate for persons

with chronic disease, such as diabetes, heart disease and hypertension. NUTRITION SUPPLIMENTS Nutrition supplements, including liquid or bars, may be made available to participants based on documented, assessed need as determined by a licensed dietitian, nutritionist or a physician. Such products cannot replace conventional meals unless a physical disability warrants their sole use. Nutrition supplements are not reimbursable under the Older Americans Act or by AoA. OFFER VERSUS SERVE

Each nutrition provider shall assure that CM participants are offered all the food items needed to meet the menu requirements.

Consistent refusal of menu items should be investigated to determine why a

participant is declining menu items.

Assistance should be provided to assure that adequate nutrition intake is maintained by the participant (for example, providing smaller serving portions, substitutions when feasible or serving the participant first).

Service Guidelines: III-C1 Congregate Meals 17 FOOD TAKEN FROM NUTRITION CONGREGATE SITES

Employees, volunteers, or participants shall not take unserved leftover foods from kitchens or Congregate Sites.

Safety of the food after it has been served to a participant and when it has been

removed from the Congregate Site is the responsibility of the recipient and may be consumed as that participant deems appropriate. Congregate Sites shall post signs to warn participants of the health hazards associated with removal of food from the congregate nutrition site.

FOOD BORNE ILLNESS COMPLAINT REPORTING REQUIREMENTS

In the event that a Nutrition Service Grantee receives a complaint or report of symptoms of food borne illness, the Nutrition Service Grantee shall;

• Notify the local health department immediately to initiate an investigation;

and • Notify AgeSmart within 24 hours of the investigative procedures in

progress.

AgeSmart shall notify the IDOA within three working days of a reported food borne illness. Thereafter, periodic updates shall be provided regarding the progress and findings of the investigation. Participants should bring their own containers if they decide to remove food served to them.

FOOD SERVICE REQUIREMENTS Nutrition Service Grantees must comply with applicable provisions of state or local laws regarding the safe and sanitary handling of food, equipment, and supplies used in the storage, preparation, service, and delivery of meals to an older individual. TRAINING

Training in fire and safety regulations must be provided during the orientation of staff new to the program and, at a minimum, once a year thereafter. The training will include but not be limited to: rules for safe work, and fire and safety regulations. Where feasible for possible, state or local officials should be involved in the development of training materials and program. In situations where regulations do not exist, or their applicability is questioned, the provider shall contact the appropriate State agency that establishes fire, or safety standards (e.g., State Fire Marshall, etc.).

• Food Service Sanitation Manager Certification:

Service Guidelines: III-C1 Congregate Meals 18

The Congregate Site supervisor or designee must successfully complete the Illinois Department of Public Health’s Food Service Sanitation Manager Certification training and have a current registration.

This is a Department on Aging requirement, and is also required by the Illinois Department of Public Health. Congregate meal sites are classified as “Category I Facilities” (non-restaurant) due to the type of population served by the congregate meal site (e.g., immune-compromised individuals such as the elderly comprise the majority of the consuming population).

The nutrition project hall have at each congregate site and/or distribution point, a site supervisor either paid or volunteer, who is responsible for all activities on-site when the site is open. The site supervisor must have successfully completed the Illinois Department of Public Health’s Food Service Sanitation certification training and have a current registration. All staff and volunteers working in the food preparation and food serving area shall be under the supervision of the site supervisor who will ensure the application of hygienic techniques and practices in food handling, preparation, service and delivery.

Food Handlers: Due to the requirements of the Food Handling Regulation Enforcement Act (410 ILCS 625), all food handlers employed by the nutrition provider (where the nutrition site is not located in a restaurant), other than someone holding a food service sanitation manager certificate, must receive or obtain training in basic food handling principles by July 1, 2016.

Definition of Food Handler: “Food handler” means an individual working with unpackaged food, food equipment or utensils, or food-contact surfaces. “Food handler does not include unpaid volunteers in a food establishment, whether permanent or temporary. After July 1, 2016. New employees shall receive training within 30 days after employment. All food handlers must renew their training every three years. Proof that a food handler has been trained shall be available upon reasonable request by the Illinois Department of Public Health or a local health department inspector and may be in electronic format. Food handlers training for those that work in non-restaurant facilities is good for three years and is not transferable between employers. Nutrition program and site volunteers performing food handling duties are not required by the Illinois Department of Public Health to receive the required training as outlined in the Food Handling Regulation Enforcement Act; however, the Illinois Department on Aging strongly encourages that nutrition programs require their volunteers to obtain such training. If the volunteers do not obtain the training based on the Food Handling

Service Guidelines: III-C1 Congregate Meals 19

Regulation Enforcement Act, the nutrition program must provide basic training to volunteers that will include but not be limited to: safe food handling, food borne illnesses, hygienic practices of personnel, equipment sanitation, dishwashing procedures, and facility sanitation. The food handling training must comply with the requirements of the Illinois Department of Public Health’s administrative rules. Note: Restaurants must comply by July 1, 2014. Training can be taken online, computer, classroom, live trainer, remote trainers and certified food sanitation managers. Approved training programs can be found on Illinois Department of Public Health web-site. The Illinois Department of Public Health has approved a “Food Safety on the Go” as a food handler training program for the Title III nutrition service providers. This can be found at: https://www.nfsc.umd.edu/programs/foodsafety Course Books, PowerPoint presentations, pre-test and post-tests, trainer guides, and module recordings are available at the above web site. Module 1 (Food Safety Basics), Module 4 (Food Service Workers) and Module 5 (Drivers) are the required sections that must be completed by the employees of the nutrition provider. Training may be conducted on-line with a computer or in a classroom setting with certified food service sanitation managers. Food handlers must take the pre-test and post-test exams, which can be used to document that the food handler has taken the required training; and proof of training shall be available upon request of the local health department. If the nutrition program does not use the “Food Safety on the Go” training program or a training program that is listed on the Illinois Department of Public Health web site, it must submit a food handler training program to the Illinois Department of Public Health for its review and approval.

FOOD TEMPERATURES

Food temperatures at the time of service must be no less than 140 degrees F for hot foods and no more than 41 degrees F for cold foods.

The temperature of the food should be checked and documented daily at the

time of service and in the case of catered food, at the time of food arrival and at the time of service.

Failure to adhere to food temperature requirements violates state and local

health regulations and may result in severe illness for the participant.

Service Guidelines: III-C1 Congregate Meals 20 REIMBURSEMENT The Grantee may receive 1/12th of the grant amount up front and then be reimbursed monthly for units served the previous month. Should reporting be late, reimbursement may be withheld. NUTRITION SERVICES INCENTIVE PROGRAM (NSIP) FOR THE EDLERLY Nutrition service providers are eligible to receive Administration for Community Living (ACL) cash assistance in the form of a funding allocation for meals served through ACL’s NSIP Program for the Elderly. Allocated funding may be claimed for meals that:

Meet the dietary guidelines as specified in the service guidelines; Are served to eligible participants, which include persons 60 years of age or

older, their spouses, disabled persons and volunteers, as described in “Eligibility” section of the service guidelines; NSIP reimbursement may NOT be claimed for meals served to guests or staff under 60 years of age.

Are served by an agency that has received a grant under Title III of the Older Americans Act and is under the jurisdiction, control, management, and audit authority of an AAA or the IDoA; and

Are provided with no set fee charged to the recipients. NSIP FUNDS:

Shall be used to increase the total number of meals served; Shall only be used to purchase U.S. agricultural commodities and other foods;

and Shall not be used to off-set program costs or as non-federal matching funds for

any other federal program. Number of meals reported in monthly NSIP reports must equal units reported in NAPIS. Funding through NSIP is provided to all OAA Title III-C1 nutrition services for all OAA Title III-C1 eligible participants on a per meal basis. NSIP reimbursement is included with the monthly unit reimbursement for the same number of meals that were provided to OAA Title III-C1 eligible participants.

Funding for AgeSmart Community Resources is received from the United States Administration for Community Living and the Illinois Department on Aging. AgeSmart does not discriminate in admission to programs or activities or treatment of employment in programs or activities in compliance with appropriate State and Federal Statutes. If you feel you have been discriminated against, you have a right to file a complaint with AgeSmart by calling 618-222-2561.

Service Guidelines: III-C1 Congregate Meals 21

Fiscal Guidelines for all Title-III Programs Program Income Program Income is defined as contributions made by recipients of service and interest on such contributions. A. Program income includes, but is not limited to:

1. Contributions of recipients of service and interest on such contributions. 2. Income from service fees obtained through the use of a sliding fee scale or

suggested fee schedule. 3. Proceeds from the sale of personal or real property with an acquisition cost of

less than $5,000. 4. Usage or rental fees. 5. Sale of assets purchased with grant funds with an acquisition cost of less than

$5,000. 6. Royalties on patents and copyrights.

B. The following specific revenues shall not be included as program income:

1. Interest income on State funds whether earned on advances or the "float". This does not include interest on contributions made by recipients of service under a project which is considered program income.

2. Rebates, discounts, and recoveries. 3. Income earned by individuals or a group of project participants, when such

income accrues directly to the participants. 4. Revenues raised by a grantee or contractor which is a government under its

governing powers, such as taxes, special assessments, etc. 5. Tuition and related fees received by an institution of higher education for a

regularly offered course taught by an employee performing under a grant or contract.

6. Proceeds from the sale of personal or real property with an acquisition cost of more than $5,000.

7. Sale of assets purchased with grant funds where the acquisition cost was more than $5,000.

8. Contributions made by representatives of service recipients, relatives, non-related individuals or entities, in behalf of service recipients are not program income, but are considered to be local cash.

9. Organized fund raising activities carried out by Title III grantee agencies.

Service Guidelines: III-C1 Congregate Meals 22 Allowable Uses of Program Income A. Additional Costs Alternative. Under this alternative, the income is used for costs which are in addition to the allowable costs of the project or program but which nevertheless further the objectives of the Federal statute under which the grant was made. Examples of purposes for which the income may be used are:

1. Expanding the program. 2. Continuing the program after grant ends. 3. Supporting other programs that further the broad objectives of the statute. 4. Obtaining equipment or other assets needed for the program or for other

activities that further the statute's objectives.

Award recipients under an Area Plan must receive prior approval by AgeSmart Community Resources for costs borne with program income under this alternative. B. Additional Requirements

1. All program income earned under Title III must stay with the service provider who earns it.

2. All program income earned under Title III, Part B, Part C-1, Part C-2 and Part E must be used only for services allowable under the part from which it was earned except as provided in (6) below.

3. All program income must be expended prior to requesting federal funds from the Department on Aging and must be expended within the fiscal year in which it was earned.

4. All program income received in the form of “cash” must be expended as it is earned to minimize cash draw down.

5. Program income earned as a result of services provided with Title III, Part B or Part E assistance may be used for any service which that contractor is authorized to provide with Title III-B or Title III-E funds.

6. Program income earned as a result of services provided with Title III C-1 or III C-2 must be used:

a. To increase the number of meals served by the project involved, b. To facilitate access to such meals, or, c. To provide other supportive services directly related to nutrition services.

7. Prior approval requests to expend program income in excess of the amount

approved on the Notification of Grant Award must be submitted on the Program Income Addendum to the Department by no later than prior to September 30th of the current fiscal year (refer to section 900 of this manual for detailed reporting requirements).

C. Special Requirements for Providers Receiving Section 5311 Funds from the U.S. Department of Transportation All transportation providers receiving support from Section 5311 and Title III-B and/or Title III-E must report rider donations as program income. Program income collected

Service Guidelines: III-C1 Congregate Meals 23 should be reported under Section 5311 and Title III-B and/or Title III-E only to the extent and in direct proportion to each funding source's financial participation. Thus, the same rider donations shall not be reported in the same amount as program income under both funding sources. Accountability for Program Income A. Program income must be deposited into an appropriate bank account or converted to money orders on a regular basis. B. Cash participant contributions should be counted by two (2) persons, placed in a safe, secure place until deposited, deposited intact, and deposit receipts compared with count sheets. Such standards require the accurate recording of amounts collected at the project and site levels and subsequent use of these funds. C. Grantees must account for program income on an on-going basis, and must report such income to AgeSmart Community Resources through the established financial reporting system. D. Accounting records and reports submitted by a recipient to AgeSmart Community Resources should provide a clear audit trail on all program income and its uses. Account records and reports should accurately reflect the receipt of such funds separately from the receipt of Federal funds, grantee funds, and the use of such resources. E. Although interest income earned on General Revenue and/or local funds by non-profit organizations is not considered program income, project grantees should maintain adequate accounting records on any interest income earned. The Department must approve AgeSmart community Resources proposed use of General Revenue Funding interest income as an activity which will further the purpose of the project and the Act. F. Rebates, discounts, and recoveries on leases should be treated as applicable credits and credited to the Federal grant accounts. Voluntary Contributions Each service provider must: 1. Provide each older person with an opportunity to voluntarily contribute to the cost of the service; 2. Protect the privacy of each older person with respect to his or her contribution; 3. Establish appropriate procedures to safeguard and account for all contributions; and 4. Use all contributions to expand the services of the provider under this part and supplement (not supplant) funds received under the Older Americans Act.

Service Guidelines: III-C1 Congregate Meals 24 Nutrition service providers must use all contributions to:

- increase the number of meals served, - facilitate access to such meals, or - to provide other supportive services directly related to nutrition services.

The service providers that receive funds under this part shall not means test for any service for which contributions are accepted or shall not deny any older person service because the older person will not or cannot contribute to the cost of service. Contributions made by older persons are considered program income.